In the practice of pulmonary and critical care medicine it is common to use either an endotracheal tube or a tracheostomy tube to maintain control over the air passages Such devices are well known and generally comprise a tube, having an inside diameter in the range of 7mm-9mm for an adult, which is positioned in the trachea to ensure that adequate ventilation and oxygenation is maintained in a safe and stable manner. The proximal end of endotracheal and tracheostomy tubes has a fitting so that the tube can be connected to a respirator or other source of air -oxygen mixture. The lower or distal end has an inflatable annular cuff to seal the tracheal zone with the exception of the endotracheal tube.
The replacement of either an endotracheal tube or a tracheostomy tube has been performed in the past by withdrawing the old tube and then through either the nose or mouth in the case of the endotracheal tube or via an incision in the neck in the case of a tracheostomy tube, placing a new tube into the trachea. This procedure is complicated, time consuming and incurs a degree of risk to the patient. It is time consuming in that the replacement essentially comprises the removal of an old tube and the insertion of a new one as though no guide or preplacement had existed. Each replacement then, is essentially a procedure which starts without any guide or indication of proper insertion location distance or the like. Moreover, during the period between removal of the old tube and insertion of the new tube, access to the tracheal area can constrict or may have already become so edematous that insertion of the new tube may be difficult or impossible because of inadequate anatomic definition.
The method of reintubation may expose the patient to risks of bleeding, trauma, airway perforation, or needless exposure to medicines which may add potential complications to the procedure, mistaken esophageal intubation, or at times hazardous positioning of the head or neck. These inherent risks would potentially expose the patient to inadequate ventilation, oxyqenation and/or airway control during this period of loss of function and the presence of the endotracheal tube.
As can be appreciated, in a situation where a patient requires an endotracheal tube to assist in a patient's life support system any delay may present potentially serious complications and/or death. In addition tracheal tube replacement is therefore considered a procedure carrying a degree of associated risk whose completion requires highly trained practitioners.